P51470 Calahaln Rd...:� .. ..,... ti.
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms _c,t' QiL� a Date me, , , f V
This permit is granted to for the installation o(f a septic tank
at the residence of Q,... -t- Address
Building Contractor Address
Septic Tank Specifications,:: Length Width Depth Capacity Gal.
Manufacturer's Name i`��on�/ Address�s_�.�i. �U
No of lines_ width__IL4. in. Total Length 1 i�ft . No. of Sq. Ft. 5eoe
Type of filter material i)i Cry a<9 _ y Total tons used -Q;?
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two --bedroom houssw 800 600
Three-bedroom house 900 900
No one shall install a septic tank in -Davie County without a permit from the Health
Officer or his agent.
Date of final approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed:
Septic TarY Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.